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Schwartz B, Weerasooriya N, Mercier R, Gould S, Saul D, Berman L. Factors Associated With Isolated Fallopian Tube Torsion in Pediatric Patients. J Pediatr Surg 2024; 59:1538-1544. [PMID: 38649311 DOI: 10.1016/j.jpedsurg.2024.03.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 03/13/2024] [Accepted: 03/26/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Isolated fallopian tube torsion (IFTT) is a rare form of adnexal torsion that is more difficult to diagnose, which may lead to delays in treatment. Our objectives were to identify clinical and radiologic factors associated with surgically-confirmed IFTT and compare them with those of patients without torsion and with adnexal torsion (AT) in a large pediatric population. METHODS We conducted a retrospective chart review of all patients who underwent surgery for suspected adnexal torsion from 2016 to 2019. Torsion was determined intraoperatively, with IFFT defined as those with only tubal but no ovarian torsion and AT defined as those with ovarian torsion, with or without involvement of the ipsilateral fallopian tube. Clinical and radiologic variables were compared between patients with IFTT and those without torsion and with AT using descriptive statistics. A previously-described composite score to predict torsion based on the presence of vomiting and adnexal volume (VVCS) was calculated for each patient. RESULTS Of 291 patients who underwent surgery for suspected torsion, 168 had confirmed torsion: 33 (19.6%) IFTT and 135 (80.4%) AT. Patients with IFTT were more likely to be younger (12.8 vs. 14.2 years, P = 0.02), premenarchal (29.0% vs. 10.7%, P = 0.009), experience nausea (90.6% vs. 70.9%, P = 0.02) and vomiting (81.3% vs. 32.8%, P < 0.001), have a paratubal cyst on imaging (18.8% vs. 2.5%, P = 0.003), and have larger adnexal volume (143.3 vs. 64.9 ml, P < 0.001) than those without torsion. Higher BMI (26.6 vs. 22.9 kg/m2, P = 0.03), a paratubal cyst on imaging (18.8% vs. 1.5%, P < 0.001), presence of arterial (65.5% vs. 44.1%, P = 0.04) and venous Doppler flow (79.3% vs. 55.9%, P = 0.02), and radiologic impression indicating lack of torsion (37.9% vs. 16.8%, P = 0.04) were more common in IFTT than AT. The accuracy of the VVCS in predicting torsion for the IFFT group was 83.9%. CONCLUSIONS IFTT has a similar clinical presentation to AT but with a higher likelihood of a paratubal cyst and preserved Doppler flow on imaging. IFTT should be strongly considered in patients who present with pain, nausea, and vomiting and have an adnexal mass separate from the ovary on imaging, regardless of Doppler flow. LEVEL OF EVIDENCE Level II. TYPE OF STUDY Prognosis study.
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Affiliation(s)
- Beth Schwartz
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA; Division of Adolescent Medicine and Pediatric Gynecology, Nemours Children's Health, Wilmington, DE, USA.
| | - Nimali Weerasooriya
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rebecca Mercier
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sharon Gould
- Division of Radiology, Nemours Children's Health, Wilmington, DE, USA
| | - David Saul
- Division of Radiology, Nemours Children's Health, Wilmington, DE, USA
| | - Loren Berman
- Department of Surgery, Nemours Children's Health, Wilmington, DE, USA
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Mariani A, Hameury F, Dubois R, Demède D, Gelas T, Mure PY, Gorduza D. Isolated Fallopian Tube Torsion in Children With Hydrosalpinx: Is Conservative Management an Option? Pediatr Emerg Care 2024; 40:582-585. [PMID: 38743405 DOI: 10.1097/pec.0000000000003209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND Isolated fallopian tube torsion (IFTT) is very rare gynecological emergency in pediatric population. Our objective is to assess treatment options and discuss outcome of a cohort of IFTT with a focus on the association between IFTT and hydrosalpinx (HSX). METHODS A retrospective review was conducted. Pediatric patients with IFTT operated in the same center were included. RESULTS Seventeen girls (aged: 11-16 years) were managed for acute abdominal pain between 2008 and 2018, with intraoperative diagnosis of IFTT. All patients underwent laparoscopic exploration, with laparoscopically fallopian tube detorsion in all patients. Based on the association of IFTT with HSX after fallopian tube detorsion, patients were divided into 2 groups: group 1 (IFTT without HSX; 12 girls) and group 2 (IFTT with HSX; 5 girls). During the same surgery, complementary surgical procedures were done. In group 1: salpingectomies (4), partial salpingectomies (2) and cystectomies (6) were done. In group 2: salpingectomy (1), salpingotomy (1), and cyst ablation (1). The treatment was called conservative when the tube was preserved.Follow-up was uneventful in group 1. In group 2, for all patients with initial fallopian tube preservation, further surgical procedures were necessary (1-4 surgeries/patient), and, finally, another 3 patients required salpingectomy. CONCLUSIONS Conservative treatment with tube preservation of IFTT without HSX appeared to be beneficial compared to those with HSX, with no recurrence of torsion or symptoms during the follow-up. However, the same conservative treatment was not sufficiently effective for IFTT with HSX and required further procedures due to recurrence of torsion. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Aurora Mariani
- From the Department of Pediatric Surgery, Centre Hospitalo Universitaire, Angers
| | - Frédéric Hameury
- Department of Pediatric Urology and Pediatric Surgery, Hopital Femme Mère et Enfant, Bron, France
| | - Rémi Dubois
- Department of Pediatric Urology and Pediatric Surgery, Hopital Femme Mère et Enfant, Bron, France
| | - Delphine Demède
- Department of Pediatric Urology and Pediatric Surgery, Hopital Femme Mère et Enfant, Bron, France
| | - Thomas Gelas
- Department of Pediatric Urology and Pediatric Surgery, Hopital Femme Mère et Enfant, Bron, France
| | - Pierre Yves Mure
- Department of Pediatric Urology and Pediatric Surgery, Hopital Femme Mère et Enfant, Bron, France
| | - Daniela Gorduza
- Department of Pediatric Urology and Pediatric Surgery, Hopital Femme Mère et Enfant, Bron, France
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Meyer J, Steinhoff-Kellner A, Stehr M, Schäfer FM. IFTT in children and adolescents-single-center experience and systematic review of literature. Pediatr Surg Int 2024; 40:143. [PMID: 38816521 DOI: 10.1007/s00383-024-05719-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE Isolated fallopian tube torsion (IFTT) is defined by rotation of the fallopian tube around itself without involving the ipsilateral ovary. It is a rare cause of acute lower abdominal pain in (adolescent) girls, but is commonly overlooked. Due to its rarity, literature is still scarce. Currently there is no generally accepted management and treatment. METHODS A retrospective analysis of all IFTT cases treated in our institution was performed. In addition, a systematic literature research on pediatric IFTT was carried out on Medline/ PubMed database according to PRISMA principles using predefined search terms and inclusion criteria. Patient characteristics regarding age, clinical symptoms, diagnostic methods, treatment, and follow-up were analyzed. RESULTS Three of our patients and fifty-nine reports totaling one hundred seventy girls were included in the analysis. Mean age was 13.0 years. Left tube was slightly more often affected (52.9%). Abdominal pain was present in 99.4% of cases accompanied with nausea in 57.1%. In only 16.4%, correct preoperative diagnosis was made. Salpingectomy was the most common treatment in 111 (66.9%) cases, 55 (33.1%) patients were treated with detorsion of the tube (organ-sparing management). Girls with symptoms longer than 1 day had a significant higher rate of salpingectomy (95% CI, P = 0.0323). CONCLUSION When IFTT is suspected, emergency laparoscopy should be performed to possibly preserve future reproductive potential. In case of detorsion and reinstated blood supply, organ-preserving management should be performed with simultaneous addressment of concomitant pathology if possible. Sufficient long-term follow-up must be assured to get significant results to introduce guidelines for children and adolescents.
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Affiliation(s)
- Johannes Meyer
- Department of Pediatric Surgery and Pediatric Urology, Cnopfsche Kinderklinik, Diakoneo, 90419, Nuremberg, Germany.
| | - Alina Steinhoff-Kellner
- Department of Gynecology and Obstetrics, Klinikum Hallerwiese, Diakoneo, 90419, Nuremberg, Germany
| | - Maximilian Stehr
- Department of Pediatric Surgery and Pediatric Urology, Cnopfsche Kinderklinik, Diakoneo, 90419, Nuremberg, Germany
| | - Frank-Mattias Schäfer
- Department of Pediatric Surgery and Pediatric Urology, Cnopfsche Kinderklinik, Diakoneo, 90419, Nuremberg, Germany
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen (FAU), 91054, Erlangen, Germany
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Koyan Karadeniz GN, Karadeniz O, Bulutlar E, Yilmaz B, Gedikbasi A, Arslan HS, Cetin BA, Polat İ. Comparison of salpingectomy and tubal detorsion procedures after experimental ischemia-reperfusion injury in a rat fallopian tube model: biochemical and histopathological evaluation. F&S SCIENCE 2024; 5:195-203. [PMID: 38580179 DOI: 10.1016/j.xfss.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/29/2024] [Accepted: 03/29/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE To compare salpingectomy and detorsion procedures and investigate the biochemical and histopathological changes in the fallopian tubes in the experimentally isolated fallopian tube torsion model in rats. DESIGN Experimental study. SETTING Experimental surgery laboratory in a training and research hospital. ANIMAL(S) Twenty-seven Sprague-Dawley rats in the reproductive period. INTERVENTION(S) Group 1, control group (n = 6); group 2, bilateral total salpingectomy group after 4 hours of tubal ischemia (n = 7); group 3: 4 hours of bilateral tubal ischemia plus 1 week of reperfusion (n = 7); and group 4, 4-hour period of bilateral tubal ischemia plus 30 days of reperfusion (n = 7). A 22-gauge catheter was administered before and after surgery using methylene blue through the uterine horn of the rat to evaluate tubal patency. MAIN OUTCOME MEASURE(S) Preoperative and postoperative serum antimüllerian hormone (AMH) levels, histopathological examination of the rat tuba uterine and histopathological damage scores, antioxidant compounds (superoxide dismutase [SOD], catalase, and glutathione peroxidase [GSH-Px]), and oxidative stress end product levels (malondialdehyde [MDA] and 8-hydroxy-2'-deoxyguanosine [8-OHdG]). RESULT(S) Although a significant difference was observed in the tissue SOD, GSH-Px, MDA, and 8-OHdG values, no significant difference was observed between the groups in serum samples. The tissue SOD and tissue GSH-Px levels in group 2 significantly decreased, and a significant increase was observed in the tissue MDA and 8-OHdG values in group 2. Among the histopathological parameters, epithelial changes, vascular congestion, and the total fallopian tube mean damage score of 4 showed a significant decrease in group 4. When the methylene blue transitions before and after ischemia-reperfusion injury were compared, the values of the methylene blue transition after ischemia-reperfusion injury in groups 2-4 significantly decreased. When the serum AMH levels were analyzed, the postoperative AMH value in group 2 significantly increased. CONCLUSION(S) This study reveals that biochemical and histopathological improvement is observed in the fallopian tube tissues gradually when the detorsion procedure is performed for the necrotized tubal tissue instead of salpingectomy. Although there is restoration of epithelial integrity after reperfusion, tubal passage remains absent. CLINICAL TRIAL REGISTRATION NUMBER This study was approved by the Local Ethics Committee for Animal Experiments of the Health Sciences University, Istanbul Hamidiye Medicine Faculty (approval number 27.05.2022-9269). The study followed the ethics standards recommended by the Declaration of Helsinki.
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Affiliation(s)
- Gizem Nur Koyan Karadeniz
- Department of Gynaecology and Obstetrics, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
| | - Ozan Karadeniz
- Department of Gynaecology and Obstetrics, Arnavutkoy State Hospital, Istanbul, Turkey
| | - Eralp Bulutlar
- Department of Obstetrics and Gynecology, Health Sciences University, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Bugra Yilmaz
- Department of Gynaecology and Obstetrics, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Asuman Gedikbasi
- Department of Biochemistry, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hilal Serap Arslan
- Department of Pathology, University of Health Sciences, Basaksehir Cam ve Sakura City Hospital, Istanbul, Turkey
| | - Berna Aslan Cetin
- Department of Gynaecology and Obstetrics, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - İbrahim Polat
- Department of Gynaecology and Obstetrics, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
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Zijun L, Yaqin Z, Weiwen P. A rare case of isolated fallopian tubal torsion in adolescent girls: A case report and system review of literature. SAGE Open Med Case Rep 2023; 11:2050313X231215207. [PMID: 38047268 PMCID: PMC10691320 DOI: 10.1177/2050313x231215207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/19/2023] [Indexed: 12/05/2023] Open
Abstract
Isolated torsion of a fallopian tube in adolescent girls is a very rare acute abdomen. How to early diagnose and treatment isolated torsion of a fallopian tube has always been one of key points. We reported a rare case of isolated torsion of a fallopian tube in a 14-year-old girl and conducted a systematic review of the literature over the past 21 years. We collected data on clinical characteristics, diagnosis and treatment, prognosis and follow-up outcomes. According to our research strategies, 43 reported cases were included. The results (Mean ± SD) showed that the onset age was 14.09 ± 2.49, the cycle torsion was 2.79 ± 1.18, and the cyst size was 6.43 ± 2.25. The main clinical symptoms (percentage) are 100% lower abdominal pain, 67.44% nausea, 51.16% vomiting, and 50.00% right side lesions. And the accurate rate of preoperative diagnosis was only 27.91%, in which laparoscopic exploration, tubal necrosis, and tubal preservation accounted for 79.07%, 41.86%, and 32.56%, respectively. Extremely difficult diagnosis of isolated torsion of a fallopian tube, because of non-specific clinical manifestations, led to the adverse clinical outcome of salpingectomy. However, the accuracy of preoperative diagnosis can be improved by improving acknowledge of ultrasound diagnosis and the awareness of clinical gynecologists. However, the accuracy of preoperative diagnosis can be improved by improving knowledge of ultrasound diagnosis and awareness of clinical gynecologists. The laparoscopic exploration is sole gold standard for diagnosis and treatment. The operation of preserving the fallopian tube may be the first choice, especially in the early stage of isolated torsion of a fallopian tube.
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Affiliation(s)
- Li Zijun
- Department of Gynecology, Longquan People’s Hospital, Longquan People’s Hospital Affiliated to Lishui University, Quzhou, Zhejiang Province, China
| | - Zheng Yaqin
- Longquan Regional Medicine Inspection Center, Longquan People’s Hospital, Longquan People’s Hospital Affiliated to Lishui University, Quzhou, Zhejiang Province, China
| | - Pang Weiwen
- Department of Pathology, Longquan People’s Hospital, Longquan People’s Hospital Affiliated to Lishui University, Lishui, Zhejiang Province, China
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Kamo N, Takahashi T, Soeda S, Jimbo M, Yoshida-Komiya H, Fujimori K. Hydrosalpinx in a premenarcheal 14-year-old girl with the proliferation of smooth muscle cells in the isthmus of the fallopian tube: A case report. J Obstet Gynaecol Res 2023; 49:769-774. [PMID: 36305392 DOI: 10.1111/jog.15481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/27/2022] [Accepted: 10/17/2022] [Indexed: 11/29/2022]
Abstract
Hydrosalpinx is rare in childhood, and its pathogenesis may differ from that in reproductive-aged women. Herein, we report a case of hydrosalpinx in a premenarcheal 14-year-old girl, which might be caused by thickening of the smooth muscle of the fallopian tube. The patient had recurrent right lower abdominal pain and was referred to our hospital with a suspected adnexal tumor. Laparoscopy revealed a hydrosalpinx with complete obstruction of the fimbria and scar-like stenosis of the proximal ampulla. Right salpingectomy was performed because of a severe hydrosalpinx. As the patient was a virgin and a vaginal culture showed normal flora, ascending infection to the fallopian tube was not considered to be the cause of the hydrosalpinx. Histopathological examination revealed that the resected fallopian tube had a markedly dilated lumen with no inflammatory cell infiltration. Immunohistochemically, estrogen- and progesterone-positive smooth muscle proliferation was found at the isthmus of the fallopian tube.
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Affiliation(s)
- Norihito Kamo
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Toshifumi Takahashi
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
| | - Shu Soeda
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Masatoshi Jimbo
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hiromi Yoshida-Komiya
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Keiya Fujimori
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
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Khorshid A, Tyson NA. Pediatric Tubal Torsion and Bilateral Hydrosalpinx as Upper Abdominal Masses. Clin Pediatr (Phila) 2022:99228221142125. [PMID: 36475328 DOI: 10.1177/00099228221142125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Arian Khorshid
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Nichole A Tyson
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Palo Alto, CA, USA
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Juliette COUTUREAU, Caroline MANDOUL, Fernanda CURROSDOYON, Ingrid MILLET, Patrice TAOUREL. Recognizing the features of Isolated Fallopian Tube Torsion on CT and MRI and interobserver agreement: a cross-sectional study. Eur J Radiol 2022; 157:110607. [DOI: 10.1016/j.ejrad.2022.110607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 10/19/2022] [Accepted: 11/08/2022] [Indexed: 11/15/2022]
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9
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Ali AM, Mohamed AN, Omar AA, Mohamed YG. Laparoscopic management of ischemic right fallopian tube torsion mimicking perforated appendicitis. Int J Surg Case Rep 2022; 93:106914. [PMID: 35298987 PMCID: PMC8927710 DOI: 10.1016/j.ijscr.2022.106914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/28/2022] [Accepted: 02/28/2022] [Indexed: 10/26/2022] Open
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10
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Harumatsu T, Komori K, Ieiri S, Hirobe S. Preoperatively detected fallopian tube torsion using MRI: A case report. Pediatr Int 2021; 63:1258-1260. [PMID: 34322954 DOI: 10.1111/ped.14597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 12/03/2020] [Accepted: 01/06/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Toshio Harumatsu
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.,Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Koji Komori
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, Kagoshima, Japan
| | - Seiichi Hirobe
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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Daniilidis A, Charitidou S, Petousis S, Margioula‐Siarkou C, Liberis A, Dinas K. Isolated torsion of the fallopian tube associated with hydrosalpinx in a 17-year-old sexually inactive girl: A case report. Clin Case Rep 2021; 9:e04794. [PMID: 34552738 PMCID: PMC8443439 DOI: 10.1002/ccr3.4794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 08/02/2021] [Accepted: 08/22/2021] [Indexed: 11/11/2022] Open
Abstract
Isolated tubal torsion is an unusual cause of acute abdominal pain in young sexually inactive patients. However, it should be still taken into account regarding the differential diagnosis of such conditions.
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Affiliation(s)
- Angelos Daniilidis
- 2nd Department of Obstetrics and GynaecologyAristotle University of ThessalonikiThessalonikiGreece
| | - Sonia Charitidou
- 2nd Department of Obstetrics and GynaecologyAristotle University of ThessalonikiThessalonikiGreece
| | - Stamatios Petousis
- 2nd Department of Obstetrics and GynaecologyAristotle University of ThessalonikiThessalonikiGreece
| | | | - Anastasios Liberis
- 2nd Department of Obstetrics and GynaecologyAristotle University of ThessalonikiThessalonikiGreece
| | - Konstantinos Dinas
- 2nd Department of Obstetrics and GynaecologyAristotle University of ThessalonikiThessalonikiGreece
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de Matos VL, Pessanha I, David DA, Gante I. Isolated torsion of a fallopian tube: an uncommon cause of abdominal pain in an 11-year-old. BMJ Case Rep 2021; 14:e243947. [PMID: 34433530 PMCID: PMC8388290 DOI: 10.1136/bcr-2021-243947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 11/04/2022] Open
Abstract
This report describes a rare case of isolated fallopian tube torsion (IFTT) in a premenarchal 11-year-old girl. The patient presented with subacute abdominal pain, associated with nausea and vomiting. Sonographic findings revealed left tube enlargement with free intraperitoneal fluid. Doppler mapping was not unequivocal. During exploratory laparoscopy, a large pelvic necrotic mass was found to be a twisted left fallopian tube. After detorsion, salpingectomy was performed and the patient recovered promptly, showing no complications 3 months post operation. IFTT should be considered as a differential diagnosis of lower abdominal pain in adolescent girls with normal-appearing ovaries on ultrasound. Conservative management for fertility preservation is the ideal approach. Therefore, avoiding delay in laparoscopy is crucial.
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Affiliation(s)
- Victória Leones de Matos
- Department of Pediatric Surgery, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Inês Pessanha
- Department of Pediatric Surgery, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Daniela Agostinho David
- Department of gynecology and obstetrics, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Inês Gante
- Department of gynecology and obstetrics, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
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Isolated Fallopian Tube Torsion: An Underdiagnosed Entity with Debatable Management. J Minim Invasive Gynecol 2021; 29:158-163. [PMID: 34371191 DOI: 10.1016/j.jmig.2021.07.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/30/2021] [Accepted: 07/30/2021] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To study features of isolated fallopian tube torsion (IFTT) to promote early diagnosis of this entity and describe options for management. DESIGN Retrospective cohort study from October 2017 through October 2020. SETTING Tertiary care hospital. PATIENTS All patients with surgically confirmed adnexal torsion or IFTT during the study period. INTERVENTIONS All of the patients underwent gynecological examination, imaging, and laparoscopy. MEASUREMENTS AND MAIN RESULTS During this 3-year period, 64 patients underwent laparoscopy owing to confirmed torsion, of which 55 had adnexal torsion, and 9 had IFTT. Patients with IFTT tended to be younger (21.2 years ± 8.2 vs 29.1 years ± 11.9, p = .06) and had more fever on admission (p = .007). On ultrasound examination, isolated hydrosalpinx was demonstrated only in patients with IFTT (p <.001). During surgery, more para-ovarian cysts were observed in patients with IFTT (44.4% vs 10.9%, p = .01), whereas patients with adnexal torsion had more ovarian cysts (52.7% vs 0%, p = .003). The most common procedure was detorsion in both groups. Most patients that underwent detorsion of the tube had a normal ultrasound scan on follow-up examination. CONCLUSION IFTT is probably underdiagnosed. Its clinical presentation is more equivocal than adnexal torsion, and ovaries are usually of normal size on ultrasonography. Hydrosalpinx or para-ovarian cysts should raise suspicion toward IFTT. Detorsion of the tube is probably a valid management option, although further research with long-term follow-up analyzing tubal patency is necessary to define the optimal management for this condition.
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14
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Scarpa MG, Iaquinto M, Codrich D, Schleef J. Bilateral sactosalphinx and congenital adrenal hyperplasia: case report on two rare conditions in two virgin girls. Ital J Pediatr 2021; 47:141. [PMID: 34187553 PMCID: PMC8244243 DOI: 10.1186/s13052-021-01089-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sactosalpinx means a collection of fluid (serum, blood or pus) in the fallopian tube. CAH (Congenital Adrenal Hyperplasia) is a typical 46XX DSD (Disorder of Sex Development) due to a steroidogenic enzymatic defect. Both conditions are rare and can lead to reduced fertility rate. CASE PRESENTATION We describe two post-menarche virgin girls with CAH who were hospitalized for acute abdomen due to laparoscopically confirmed sactosalpinx. Case 1 recovered after conservative management, case 2 after a second-look and bilateral salpingectomy. The first case consisted of right sactosalpinx and previous peritonitis reported; the second one of bilateral symptomatic pyosalpinx and previous vaginal stenosis. Recurrent abdominal pain persisted at follow-up in Case 1: post-operative MRI (Magnetic Resonance Imaging) showed bilateral hydrosapinx that disappeared at a following ultrasound scan control. Follow-up was uneventful 36 months after surgery in Case 2, except for the surgical revision of the vaginal introitus. CONCLUSIONS CAH-sactosalpinx association is a very rare but not negligible event. We suggest a conservative approach for sactosalpinx if tubal and/or ovary torsion can be excluded. Pyosalpinx is more challenging to treat, but during pediatric age we suggest starting with a conservative approach, especially in patients with CAH who have a potential low fertility rate. Careful gynecological follow-up after menarche is recommended to rule out any further causes of infertility.
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Affiliation(s)
- Maria-Grazia Scarpa
- Pediatric Surgery Department - Institute for Maternal and Child Health, IRCCS Burlo Garofolo, via dell'Istria, 65/1, Trieste, Italy.
| | - Marianna Iaquinto
- Pediatric Surgery Department - Institute for Maternal and Child Health, IRCCS Burlo Garofolo, via dell'Istria, 65/1, Trieste, Italy
| | - Daniela Codrich
- Pediatric Surgery Department - Institute for Maternal and Child Health, IRCCS Burlo Garofolo, via dell'Istria, 65/1, Trieste, Italy
| | - Jürgen Schleef
- Pediatric Surgery Department - Institute for Maternal and Child Health, IRCCS Burlo Garofolo, via dell'Istria, 65/1, Trieste, Italy
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15
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Delacroix C, Hcini N, Vintejoux E, Kedous S, Carles G. Isolated tubal twist: A case series of a rare event occurring at different times in reproductive life. Int J Surg Case Rep 2021; 80:105688. [PMID: 33667912 PMCID: PMC7933738 DOI: 10.1016/j.ijscr.2021.105688] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 12/02/2022] Open
Abstract
Isolated fallopian tube torsion is a rare but potentially serious event occurring at different times in reproductive life. This diagnosis is often overlooked before surgery. It should be evoked in front acute pelvic pain in patients with history of hydrosalpinx or paratubal cyst. Conservative management must be privileged especially in woman of childbearing age and in a pediatric population.
Introduction and importance Isolated fallopian tube torsion (IFTT) is a rare but potentially serious cause of pelvic pain in women. Despite being a surgical emergency, this diagnosis is often overlooked before surgery. To raise awareness of this diagnosis among clinicians, we describe here five cases, which occurred at different times in reproductive life. Cases presentation We present five cases of isolated fallopian tube torsion at different ages (13–54 years). It often manifests with sudden onset of acute pelvic pain in four cases and chronic pelvic pain in one case. At admission, patients were suspected of adnexal torsion (3 cases), genital infection (1 case), and renal pain (1 case). CT-scan showed IFTT in only one patient. Laparoscopic surgical management, performed by experienced surgeons, consisted of salpingectomy in 4 cases and conservative treatment in one case. The latter was complicated with hydrosalpinx 6 years later. All patients were followed in outpatient clinic at least one time after surgery and had favorable outcomes. Clinical discussion Given the rarity of the pathology and the lack of pathognomonic imaging, IFTT is rarely diagnosed before surgery. Its etiology is still unknown but hydrosalpinx following an infectious process seems to be a major risk factor. Conclusion Increasing awareness of this rare entity is advocated, especially in woman of reproductive age. Torsion should be evoked in front acute pelvic pain in patients with hydrosalpinx or paratubal cyst. Conservative management must be privileged especially in women of childbearing age and in pediatric population.
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Affiliation(s)
- C Delacroix
- Department of Obstetrics and Gynaecology, West French Guiana Hospital Center, Saint-Laurent-du-Maroni, French Guiana
| | - N Hcini
- Department of Obstetrics and Gynaecology, West French Guiana Hospital Center, Saint-Laurent-du-Maroni, French Guiana.
| | - E Vintejoux
- Department of Obstetrics and Gynaecology, Arnaud de Villeneuve Hospital, Montpellier, France
| | - S Kedous
- Department of Obstetrics and Gynaecology, West French Guiana Hospital Center, Saint-Laurent-du-Maroni, French Guiana
| | - G Carles
- Department of Obstetrics and Gynaecology, West French Guiana Hospital Center, Saint-Laurent-du-Maroni, French Guiana
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16
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Riccio A, Lisi G, Miscia ME, Di Paolo G, Lauriti G, Lelli Chiesa P. Secondary hydrosalpinx in adolescents: a challenging decision-making process for surgical choice and future fertility preservation. LA PEDIATRIA MEDICA E CHIRURGICA 2021; 42. [PMID: 33601874 DOI: 10.4081/pmc.2020.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 01/18/2021] [Indexed: 11/23/2022] Open
Abstract
Hydrosalpinx in pre-pubertal children and non-sexually active adolescents is a rare finding with several etiology and negative impact on future female fertility. The therapeutic approach in these specific populations is debated and it must consider its etiology and adult guidelines focused on fertility issues, which suggest laparoscopic salpingectomy. We described two adolescent cases (15 years asymptomatic and 13 years with abdominal pain) presenting a monolateral hydrosalpinx secondary to surgery for Hirschsprung's disease and complicated appendicitis, respectively. Both patients underwent to uncomplicated robotic-assisted salpingectomy, with uneventful follow-up and preserved ovarian function. Robotic-assisted salpingectomy for hydrosalpinx secondary to previous surgical conditions is a safe and careful approach for adolescents in order to preserve ovarian vascularization, function and future fertility.
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Affiliation(s)
- Angela Riccio
- Pediatric Surgery Unit, Hospital "Spirito Santo", Pescara - University "G. d'Annunzio", Chieti-Pescara.
| | - Gabriele Lisi
- Pediatric Surgery Unit, Hospital "Spirito Santo", Pescara - University "G. d'Annunzio", Chieti-Pescara.
| | - Maria Enrica Miscia
- Pediatric Surgery Unit, Hospital "Spirito Santo", Pescara - University "G. d'Annunzio", Chieti-Pescara.
| | - Gilda Di Paolo
- Service of Pediatric and Adolescent Gynecology, Department of Medicine and Aging Science, University "G. d'Annunzio" of Chieti-Pescara.
| | - Giuseppe Lauriti
- Pediatric Surgery Unit, Hospital "Spirito Santo", Pescara - University "G. d'Annunzio", Chieti-Pescara.
| | - Pierluigi Lelli Chiesa
- Pediatric Surgery Unit, Hospital "Spirito Santo", Pescara - University "G. d'Annunzio", Chieti-Pescara.
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17
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Martín-Vallejo J, Garrigós-Llabata EE, Molina-Bellido P, Clemente-Pérez PA. Isolated fallopian tube torsion associated with hydrosalpinx in a 12-year-old girl: a case report. J Med Case Rep 2020; 14:165. [PMID: 32921316 PMCID: PMC7488696 DOI: 10.1186/s13256-020-02462-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 07/27/2020] [Indexed: 12/07/2023] Open
Abstract
Background Isolated fallopian tube torsion associated with hydrosalpinx is a rare condition in the pediatric population. We present this unusual clinical case study in a sexually inactive girl. Case presentation a12-year-old Caucasian girl presented symptoms of acute abdominal pain. Pelvic ultrasound revealed a normal looking uterus and ovaries and next to left ovary a imaging compatible with hydrosalpinx. She was discharged 48 hours later after clinical monitoring with oral analgesia and normal blood workup. At 3 weeks, she was readmitted for acute abdominal pain. Leukocytosis with left shift and raised C-reactive protein were observed. Her clinical condition worsened, and complication of the preexisting hydrosalpinx was suspected. Exploratory laparoscopy confirmed torsion of the fallopian tube. Left salpingectomy was performed. Histopathologic study confirmed a fallopian tube with hemorrhagic infarct. Conclusion Torsion of the fallopian tube must be considered in the event of acute abdominal pain. Early diagnosis and trying conservative management with a view to preserving fertility in this group of patients are essential.
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Affiliation(s)
- Javier Martín-Vallejo
- Department of Obstetrics and Gynecology, Hospital de Denia, Avenida Marina Alta, s/n, 03700, Denia, Alicante, Spain.
| | - Enrique E Garrigós-Llabata
- Department of Obstetrics and Gynecology, Hospital de Denia, Avenida Marina Alta, s/n, 03700, Denia, Alicante, Spain
| | - Patricia Molina-Bellido
- Department of Obstetrics and Gynecology, Hospital de Denia, Avenida Marina Alta, s/n, 03700, Denia, Alicante, Spain
| | - Pedro A Clemente-Pérez
- Department of Obstetrics and Gynecology, Hospital de Denia, Avenida Marina Alta, s/n, 03700, Denia, Alicante, Spain
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18
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Balasubramaniam D, Duraisamy KY, Ezhilmani M, Ravi S. Isolated Fallopian Tube Torsion: A Rare Twist with a Diagnostic Challenge That May Compromise Fertility. J Hum Reprod Sci 2020; 13:162-167. [PMID: 32792767 PMCID: PMC7394095 DOI: 10.4103/jhrs.jhrs_143_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 12/14/2019] [Accepted: 02/28/2020] [Indexed: 11/20/2022] Open
Abstract
Isolated Fallopian tube torsion (IFTT) is a rare entity with utmost important gynecological emergency with difficult preoperative diagnosis. Our aim is to analyze the clinical presentation, risk factors, and management of IFTT. We retrospectively analyzed all patients with intraoperative diagnosis of IFTT in our endogynecological department over a time period of 3 years and 6 months (January 2015–June 2018) in a tertiary level laparoscopic center. The clinical profile of the patients was analyzed and the results formulated. Statistical analysis was done by SPSS system, Version 15.00 (SPSS Inc., Chicago). A total 17 cases were diagnosed with IFTT with or without pathology. The mean age was 28.07 ± 11.3 years. Lower abdominal pain was the most common symptom (88%). About 47% had a history of tubal ligation. Salpingectomy was done in the majority of the patients (82.3%). Detorsion and preservation of the tube was possible in 17.6% of the cases. High index of suspicion is needed to diagnose this rare cause of acute abdomen. Hence, an early intervention can enhance the salvageability of the affected tubes which has a positive impact on the fertility status of the patients. Tubal preservation is the preferred procedure of choice whenever feasible.
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Affiliation(s)
- Devi Balasubramaniam
- Department of Endogynecology, Gem Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | | | - Malathi Ezhilmani
- Department of Endogynecology, Gem Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Saranya Ravi
- Department of Endogynecology, Gem Hospital and Research Centre, Coimbatore, Tamil Nadu, India
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19
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Bertozzi M, Noviello C, Molinaro F, Ratta A, Lisi G, Cobellis G, Federici S, Chiesa PL, Martino A, Messina M. Isolated fallopian tube torsion in pediatric age: An Italian multicenter retrospective study. J Pediatr Surg 2020; 55:711-714. [PMID: 31130349 DOI: 10.1016/j.jpedsurg.2019.04.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/24/2019] [Accepted: 04/27/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of this study was to quantify the experience of five Italian centers on the diagnosis and management of isolated fallopian tube torsion (IFTT) in children. METHODS We retrospectively reviewed the data of 20 patients aged 1-16 years of age with surgically diagnosed IFTT between 1991 and 2017 from five Italian centers of pediatric surgery. We analyzed common presenting signs, symptoms, and radiographic findings, as well as surgical interventions to describe management offering further insight into the diagnosis and treatment of this rare entity. RESULTS Twenty cases of IFTT were collected. Median age was 13.1 years. Menarche was present in 14 cases. A clinical history of abdominal pain was present in 13 patients, whereas in 7 patients the clinical picture was an acute abdomen. Ultrasonography was the first diagnostic examination in 16 cases. Surgical approach was by laparoscopy in 16 cases and laparotomy in 4 cases. In 11 patients IFTT was associated with another pathologic condition. In 7 of the remaining 9 IFTT without pathologic association, the girls played sports. Salpingectomy was performed in 13 patients and de-torsion in 7. CONCLUSIONS IFTT is a rare condition that seems to occur in younger adolescents. Vague clinical presentation contributes to low preoperative suspicion. IFTT should be considered in girls with abdominal pain who practice sports with sudden body movements. Preoperative suspicion may be increased based on radiographic findings of an enlarged tubular/cystic structure with adjacent normal ovary. Conservative management is controversial but could be preferred in order to provide the best option for future fertility of these girls. TYPE OF STUDY Treatment Study (Retrospective Study) - Level IV.
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Affiliation(s)
- Mirko Bertozzi
- Pediatric Surgery Unit- University of Perugia - Azienda Ospedaliera di Perugia - S. Maria della Misericordia Hospital -, Perugia, - Italy.
| | - Carmine Noviello
- Pediatric Surgery Unit, Salesi Children's Hospital, Politecnica delle Marche University, Ancona, Italy
| | - Francesco Molinaro
- Pediatric Surgery Unit, Department of Medical Science, Surgery and Neuroscience, University of Siena -, Siena, - Italy
| | - Alberto Ratta
- Pediatric Surgery Unit - Infermi Hospital -, Rimini, - Italy
| | - Gabriele Lisi
- Pediatric Surgery Department - G. D'Annunzio University of Chieti - Pescara -, Chieti, - Italy
| | - Giovanni Cobellis
- Pediatric Surgery Unit, Salesi Children's Hospital, Politecnica delle Marche University, Ancona, Italy
| | | | - Pierluigi Lelli Chiesa
- Pediatric Surgery Department - G. D'Annunzio University of Chieti - Pescara -, Chieti, - Italy
| | - Ascanio Martino
- Pediatric Surgery Unit, Salesi Children's Hospital, Politecnica delle Marche University, Ancona, Italy
| | - Mario Messina
- Pediatric Surgery Unit, Department of Medical Science, Surgery and Neuroscience, University of Siena -, Siena, - Italy
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20
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Chappalley D, Birraux J, Vidal I, Sanchez O, Merlini L, Brönnimann E. Unusual isolated fallopian tube torsion. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2019.101375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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21
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Adeyemi-Fowode O, Lin EG, Syed F, Sangi-Haghpeykar H, Zhu H, Dietrich JE. Adnexal Torsion in Children and Adolescents: A Retrospective Review of 245 Cases at a Single Institution. J Pediatr Adolesc Gynecol 2019; 32:64-69. [PMID: 30012428 DOI: 10.1016/j.jpag.2018.07.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/02/2018] [Accepted: 07/09/2018] [Indexed: 12/18/2022]
Abstract
STUDY OBJECTIVE Adnexal torsion (AT) requires urgent surgical intervention to preserve ovarian function. Historically, treatment for AT was oophorectomy because of concerns related to leaving a nonviable ischemic ovary. No published studies support these theoretical concerns and current literature supports conservative management. The aim of this study was to review the institutional outcomes for AT cases, including salvage rates and complications. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: This study was approved by the institutional review board at Baylor College of Medicine. A retrospective chart review on cases of AT from 2007 to 2016 at a single Children's hospital was performed on the basis of International Classification of Diseases, 10th revision and Current Procedural Terminology codes. A standardized chart review form was used in data extraction. Statistical analysis was performed using SAS version 9.4 (SAS Institute). RESULTS Chart review identified 245 torsion cases in 237 patients. The mean age was 12.4 ± 3.29 years. Of the participants, 230 (94%) underwent minimally invasive laparoscopy with ovarian preservation in 233 (95%) of the cases. There were no complications due to detorsion of the affected adnexa. Intraoperatively, the right adnexa was affected in 134 (55%) cases and a lesion was noted in 193 (79%) cases, most commonly paratubal cysts and mature teratomas. The malignancy rate was low, noted only in 4/245 patients at (1.2%). Pediatric gynecology performed most of the cases (n = 214; 87%). CONCLUSION The findings of our study continue to support the conservative management of patients with AT.
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Affiliation(s)
- Oluyemisi Adeyemi-Fowode
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas; Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
| | - Emily G Lin
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | - Fatima Syed
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
| | | | - Huirong Zhu
- Outcomes and Impact Service, Texas Children's Hospital, Houston, Texas
| | - Jennifer E Dietrich
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas; Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
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22
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Palazón P, Saura L, de Haro I, Martín-Solé O, Albert A, Tarrado X, Julià V. Bilateral hydrosalpinx in patients with Hirschsprung's disease. J Pediatr Surg 2018; 53:1945-1950. [PMID: 29467083 DOI: 10.1016/j.jpedsurg.2018.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 11/30/2017] [Accepted: 01/09/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE Hirschsprung's disease (HD) is uncommon in females. There are very few reports on the patients' obstetric and gynecological outcome. Hydrosalpinx causes pain and infertility. It is rare in nonsexually active teenagers. It may be because of an intrinsic disease of the fallopian tubes or secondary to surgery. AIM to describe the relationship between hydrosalpinx and HD or its surgical approach; to report the impact of bilateral hydrosalpinx on fertility in HD. METHODS The records of all females with HD since 1980 were reviewed. Only patients who reached menarche were included. Prevalence of hydrosalpinx and hydrosalpinx-free survival were compared after abdominoperineal (A) or transanal (T) surgery. Treatment for hydrosalpinx was reviewed. RESULTS Seventeen out of 27 patients had reached menarche (Group A: 13 patients; Group T: 4 patients). Five patients in group A and none in group T presented bilateral hydrosalpinx (p=0.261). There were no statistical differences in hydrosalpinx-free survival between groups (p=0.344). Hydrosalpinx treatment: two bilateral and one unilateral salpingectomy, one pyosalpinx evacuation and one untreated. Three patients had conception desire: one has children; two are on IVF program. CONCLUSION An association between hydrosalpinx and HD was observed. The development of hydrosalpinx was not associated with surgical approach in our study. Females with HD should have a gynecological follow-up for the development of hydrosalpinx, which can impair fertility. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Pedro Palazón
- Department of Pediatric Surgery, Hospital Sant Joan de Déu-Universitat de Barcelona, Passeig de Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona, Spain.
| | - Laura Saura
- Department of Pediatric Surgery, Hospital Sant Joan de Déu-Universitat de Barcelona, Passeig de Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Irene de Haro
- Department of Pediatric Surgery, Hospital Sant Joan de Déu-Universitat de Barcelona, Passeig de Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Oriol Martín-Solé
- Department of Pediatric Surgery, Hospital Sant Joan de Déu-Universitat de Barcelona, Passeig de Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Asteria Albert
- Department of Pediatric Surgery, Hospital Sant Joan de Déu-Universitat de Barcelona, Passeig de Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Xavier Tarrado
- Department of Pediatric Surgery, Hospital Sant Joan de Déu-Universitat de Barcelona, Passeig de Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Victoria Julià
- Department of Pediatric Surgery, Hospital Sant Joan de Déu-Universitat de Barcelona, Passeig de Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona, Spain
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Raban O, Zilber H, Hadar E, Efrat Z, Krissi H, Wiznitzer A, Meizner I, Bardin R. Isolated Fallopian Tube Torsion: A Unique Ultrasound Identity or a Serial Copycat? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2387-2393. [PMID: 29573346 DOI: 10.1002/jum.14595] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/09/2018] [Accepted: 01/11/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To report the preoperative ultrasound (US) signs of isolated fallopian tube torsion in surgically verified cases and to estimate whether preoperative US detection of this condition can be improved. METHODS The charts of 27 women with a surgical diagnosis of isolated fallopian tube torsion at a tertiary medical center from 2005 to 2016 were retrospectively reviewed. Data were collected from the electronic database of the US unit and compared with the surgical findings. RESULTS Isolated fallopian tube torsion was correctly diagnosed by US before surgery in 8 of the 27 women (29.6%). In the remainder, the US signs were attributed to torsion of the ovary or the entire adnexa (n = 13), or no torsion was suspected (n = 6). Fallopian tube edema was listed as a US finding in 7 patients, of whom 5 had a correct diagnosis of isolated fallopian tube torsion. The presence of a paraovarian cyst concomitant with normal-appearing ovaries was assumed by US in 5 of the 8 cases that were accurately diagnosed as isolated fallopian tube torsion. The most misinterpreted US finding was an ovarian cyst (suspected in 10 patients and verified at surgery in 2). Absence of blood flow was described in 12 women, of whom 5 had an accurate diagnosis of isolated fallopian tube torsion. Six of the patients with a correct US diagnosis were adults (37.5% of total adults), and 2 were adolescents (18.2% of total adolescents). CONCLUSIONS The US diagnosis of isolated fallopian tube torsion is challenging. A high index of suspicion is necessary to improve its detection, especially when there are possible US signs of torsion in the presence of a normal-appearing ovary.
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Affiliation(s)
- Oded Raban
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hila Zilber
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zeev Efrat
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Krissi
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Wiznitzer
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Israel Meizner
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Bardin
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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24
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Zaat TR, Braakhekke MWM, Kaaijk EM, Peters LW. Quadruple torsion of the fallopian tube in an 18-year-old virgin: a rare twist. BMJ Case Rep 2018; 2018:bcr-2018-224671. [PMID: 30131412 DOI: 10.1136/bcr-2018-224671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In this report, we describe an 18-year-old nulliparous virgo, with no medical history, who presented herself at the emergency department with symptoms of lower abdominal pain and nausea with vomiting. On examination, an echogenic unilocular cyst with possible relation to the right ovary was found. The working diagnosis was an ovarian torsion. She underwent a diagnostic laparoscopy which revealed a quadruple torsion of the fallopian tube with hydrosalpinx. Detorsion of the tube was performed, and the tube was drained using diathermic incision. After the surgery, the patient recovered rapidly. Ultrasonic evaluation 38 days later showed an echogenic area measuring 2×3 cm suspected for persistent hydrosalpinx. Because of the asymptomatic postoperative period, the patient was treated conservatively, and no further treatment was performed.
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Affiliation(s)
- Tjitske R Zaat
- Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | | | - Eugenie M Kaaijk
- Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Louisette W Peters
- Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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25
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Adeyemi-Fowode O, McCracken KA, Todd NJ. Adnexal Torsion. J Pediatr Adolesc Gynecol 2018; 31:333-338. [PMID: 29653167 DOI: 10.1016/j.jpag.2018.03.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 03/28/2018] [Accepted: 03/30/2018] [Indexed: 12/17/2022]
Abstract
Adnexal torsion is an uncommon gynecologic disorder caused by the partial or complete rotation of the ovary and/or the fallopian tube on its vascular support. Delay in treatment can impact fertility adversely. The objective of this report is to provide clinical recommendations based on the latest evidence. Specifically we discuss epidemiology, clinical presentation, diagnostic approach and management of adnexal torsion in adolescents.
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Affiliation(s)
- Oluyemisi Adeyemi-Fowode
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
| | - Kate A McCracken
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Ohio State University, Columbus, Ohio
| | - Nicole J Todd
- Division of General Gynaecology and Obstetrics, University of British Columbia, Vancouver, British Columbia, Canada
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Chanu SM, Rudra Pal GS, Panda S, Santa Singh AS. Diagnostic Hysterolaparoscopy for Evaluation of Infertility: Our Experience in a Tertiary Care Hospital. J Hum Reprod Sci 2018; 11:19-23. [PMID: 29681711 PMCID: PMC5892098 DOI: 10.4103/jhrs.jhrs_114_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: The objective of this study is to analyze the role of diagnostic hysterolaparoscopy (DHL) for evaluation of infertility in a tertiary care hospital. Materials and Methods: This retrospective study was conducted from July 2014 to June 2016. Results: Out of 151 patients, 58.28% and 41.72% had primary and secondary infertility, respectively. In primary infertility group 37.5% and in secondary infertility group 49.2% had abnormal findings. Most common finding was adnexal adhesions (pelvic inflammatory disease) and laparoscopic findings were more common than the hysteroscopic ones. Conclusion: DHL was helpful in finding some reversible causes of infertility such as adnexal adhesions, tubal blockade, and uterine synechiae, etc.
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Affiliation(s)
| | | | - Subrat Panda
- Departments of Obstertics and Gynaecology, NEIGRIHMS, Shillong, Meghalaya, India
| | - A S Santa Singh
- Departments of Obstertics and Gynaecology, NEIGRIHMS, Shillong, Meghalaya, India
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Archambeau C, Labaisse MA, Etobou C, Dutrieux JL, Stalens JP, Gillerot S, Wayemberg M. Torsion tubaire isolée : ne ratons pas le diagnostic ! À propos de deux cas pédiatriques. IMAGERIE DE LA FEMME 2017. [DOI: 10.1016/j.femme.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bertozzi M, Magrini E, Riccioni S, Giovenali P, Appignani A. Isolated fallopian tube torsion with hydrosalpinx: Review of a debated management in a pediatric population. J Pediatr Surg 2017; 52:1553-1560. [PMID: 28735977 DOI: 10.1016/j.jpedsurg.2017.07.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 06/07/2017] [Accepted: 07/09/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To quantify our experience with and assess the literature on diagnosis and management of isolated fallopian tube torsion (IFTT) with hydrosalpinx (HSX) in children. METHODS A PubMed search was performed on pediatric cases of IFTT with HSX to provide a comprehensive review analyzing details and management of this association, focusing on the problem of fertility preservation. RESULTS In addition to our 3 cases, 17 patients of pediatric IFTT associated with HSX were identified, for a total of 21 cases (median age 12.2 years). Menarchal status was present in 10/13 (76.9%); blood tests were reported in 9/20 (42%) showing leucocytosis in 7/9 (75%). Ultrasonography was performed in all cases except one. Laparoscopy was the surgical approach in 84.6% of the reported cases. The torsion was to the right in 36.8%, and to the left in 63.2% of the cases. In one case the torsion was bilateral and asynchronous. Performed procedures were salpingectomy (52.4%) and partial salpingectomy (14.3%); conservative management was reported in 33.3% of the cases. CONCLUSIONS The literature describes different management techniques. Salpingectomy is the most frequently performed procedure but recently conservative management seems to be increasingly applied. A long-term study is necessary to define the most effective treatment for the preservation of future fertility in pediatric patients. TYPE OF STUDY Treatment study (Retrospective Study): LEVEL IV.
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Affiliation(s)
- Mirko Bertozzi
- S.C. di Clinica Chirurgica Pediatrica, University of Perugia, S. Maria della Misericordia Hospital, Loc. S. Andrea delle Fratte, 06100 Perugia, Italy.
| | - Elisa Magrini
- S.C. di Clinica Chirurgica Pediatrica, University of Perugia, S. Maria della Misericordia Hospital, Loc. S. Andrea delle Fratte, 06100 Perugia, Italy
| | - Sara Riccioni
- Sezione di Radiologia, Dipartimento di Scienze Chirurgiche, Radiologiche ed Odontostomatologiche, University of Perugia, S. Maria della Misericordia Hospital, Loc. S. Andrea delle Fratte, 06100 Perugia, Italy
| | - Paolo Giovenali
- S.S. Dipartimentale Citologia ed Istologia Diagnostica, S. Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Loc. S. Andrea delle Fratte, 06100 Perugia, Italy
| | - Antonino Appignani
- S.C. di Clinica Chirurgica Pediatrica, University of Perugia, S. Maria della Misericordia Hospital, Loc. S. Andrea delle Fratte, 06100 Perugia, Italy
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Clinical Predictors of Isolated Tubal Torsion: A Case Series. J Pediatr Adolesc Gynecol 2017; 30:578-581. [PMID: 28571941 DOI: 10.1016/j.jpag.2017.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 05/02/2017] [Accepted: 05/07/2017] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVE A rare cause of adolescent abdominal pain includes isolated tubal torsion (ITT). Presentation is nonspecific and few studies have investigated ITT in adolescents. Our study objective was to describe the presentation and management of ITT in a large case series. DESIGN Retrospective observational case series. SETTING Tertiary care children's hospital. PARTICIPANTS Participants were female and aged 3-21 years, presenting to Children's Hospital Colorado and diagnosed with ITT between January 2004 and August 2015. INTERVENTIONS AND MAIN OUTCOME MEASURES Clinical presentation, physical exam, laboratory findings, surgical diagnosis, and treatment provided. RESULTS A total of 19 cases were included. Average age was 13.3 (range, 11-18) years. In patients with unilateral abdominal pain (n = 16), there was 100% correlation with side of adnexal pathology. Ultrasound examination in 14 of 18 cases (78%) noted abnormal findings ipsilateral to the ITT. Most cases were managed with laparoscopy (84%; n = 16 of 19) and detorsion with or without cystectomy (74%; n = 14 of 19). Salpingectomy was more common with prolonged pain greater than 24 hours (relative risk 5.6, 95% confidence interval, 0.7-39.0). The most common intraoperative finding was a paratubal cyst (74%; n = 14 of 19). When Doppler flow was performed, it was present in 88% (n = 16 of 18) of the affected adnexa. ITT was more common on the left side (68%; n = 13 of 19). CONCLUSION The high occurrence of paratubal cysts might suggest pathologic predisposition for ITT. Providers should maintain a high index of suspicion for ITT, particularly if associated with a paratubal cyst. Classic examination findings of surgical abdomen, leukocytosis, fever, and absence of Doppler flow are infrequently present. Laparoscopy and detorsion are appropriate treatments for managing ITT.
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Fadıloğlu E, Dur R, Demirdağ E, Öztürk Ç, Fadıloğlu Ş, Kaplan M, Tapısız ÖL. Isolated tubal torsion: Successful preoperative diagnosis of five cases using ultrasound and management with laparoscopy. Turk J Obstet Gynecol 2017; 14:187-190. [PMID: 29085710 PMCID: PMC5651895 DOI: 10.4274/tjod.57984] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 06/13/2017] [Indexed: 12/01/2022] Open
Abstract
Our aim was to evaluate the presentation and diagnostic evaluation of patients with isolated tubal torsion and to evaluate the surgical approach to these patients. We also aimed to define the ultrasonographic diagnostic criteria. Five patients with isolated tubal torsion who were admitted to our gynecology department between January 2014 and January 2017 were evaluated and included in this study. All cases were diagnosed through ultrasonographic imaging alone. The preoperative findings of the patients were similar to those described in the literature. No further imaging modality was used for diagnosis and all patients were managed with laparoscopy. The clinical findings and ultrasonographic findings were consistent with literature. It may be difficult to preoperatively diagnose isolated tubal torsion, which is a rare clinical entity. Evaluation of these patients by an experienced sonographer and knowledge of the ultrasonographic findings of isolated tubal torsion may have vital preventive measures.
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Affiliation(s)
- Erdem Fadıloğlu
- University of Health Sciences, Ankara Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Rıza Dur
- University of Health Sciences, Ankara Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Erhan Demirdağ
- University of Health Sciences, Ankara Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Çağatayhan Öztürk
- University of Health Sciences, Ankara Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Şeyma Fadıloğlu
- Ankara Numune Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Metin Kaplan
- University of Health Sciences, Ankara Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Ömer Lütfi Tapısız
- University of Health Sciences, Ankara Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
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A rare cause of acute abdominal pain in children: Isolated tubal torsion; a case series. Turk J Emerg Med 2017; 17:73-76. [PMID: 28616621 PMCID: PMC5459521 DOI: 10.1016/j.tjem.2016.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 11/09/2016] [Accepted: 12/23/2016] [Indexed: 11/21/2022] Open
Abstract
Isolated tubal torsion -a rare cause of acute abdomen in children-is usually difficult to diagnose because of non-specific findings. Surgical salphingectomy is required in delayed diagnosis in most cases. Three sexual inactive adolescents diagnosed in isolated tubal torsion (ITT) were discussed for its diagnostic features and surgical management. Laboratory tests and radiological studies including ultrasonography (US), color doppler ultrasound were performed in all patients after evaluation for acute lower abdominal pain in emergency department and they underwent surgical intervention with laparotomy (n:2) and laparoscopy (n:1). One of the patients in this study had salpingectomy. Detorsion of the fallopian tube and cyst excision were performed in the remaining two patients who also had paratubal cysts. There was no recurrence in these patients during the follow-up for 3 and 2 years. The isolated tubal torsion should be kept in mind and early surgical management is essential in order to preserve fallopian tube because of its importance in fertility.
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Sakuragi M, Kido A, Himoto Y, Onishi Y, Togashi K. MRI findings of isolated tubal torsions: case series of 12 patients. Clin Imaging 2017; 41:28-32. [DOI: 10.1016/j.clinimag.2016.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 07/22/2016] [Accepted: 09/22/2016] [Indexed: 10/20/2022]
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Torsion of Hydrosalpinx with Concurrent Acute Cholecystitis: Case Report and Review of Literature. Case Rep Surg 2016; 2016:5424092. [PMID: 28070439 PMCID: PMC5192327 DOI: 10.1155/2016/5424092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 11/24/2016] [Indexed: 01/11/2023] Open
Abstract
Introduction. Isolated torsion of the Fallopian tube is an uncommon cause of acute lower abdominal pain and can occur in women of all age groups. Cholecystitis is a frequent cause of upper abdominal pain. We present an unusual case with the presence of these two distinct pathological entities occurring concurrently in the same patient, causing simultaneously occurring symptoms. To our knowledge, this is the first reported presentation of such a case. Methods. We describe a 34-year-old premenopausal woman who presented with right sided upper and lower abdominal pain and nausea. Abdominal ultrasound (US) revealed acute cholecystitis. Vaginal US was suggestive of right hydrosalpinx. Intravenous antibiotics were administered and consent was obtained for operative intervention. During laparoscopy, the right Fallopian tube with hydrosalpinx was noted to be twisted three times. The right ovary appeared normal. The gall bladder wall was thickened and inflamed. Laparoscopic right salpingectomy and cholecystectomy were performed. Results. Surgical pathology revealed hydrosalpinx with torsion and acute calculous cholecystitis. The patient had an uneventful postoperative course and was discharged home on the first postoperative day. Her symptoms resolved after the procedure. Conclusions. In women with abdominal pain, both gynecologic and nongynecologic etiologies should be considered in the differential diagnoses. Concurrent presence of symptomatic gynecologic and nongynecologic intra-abdominal pathology is rare. Isolated Fallopian tube torsion is rare and is associated most often with hydrosalpinx. Some torqued Fallopian tubes can be salvaged. Laparoscopy is useful in management of both Fallopian tube torsion and cholecystitis.
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Fallopian Tube Torsion as a Cause of Acute Pelvic Pain in Adolescent Females. Case Rep Pediatr 2016; 2016:8707386. [PMID: 27818824 PMCID: PMC5081442 DOI: 10.1155/2016/8707386] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 09/25/2016] [Indexed: 11/28/2022] Open
Abstract
Purpose. Torsion of the fallopian tube, involving hydatids of Morgagni, though a rare cause of acute pelvic pain in young girls, can pose significant risks to future fertility. Tubal torsion may present as a diagnostic dilemma since the ovary itself usually appears normal on ultrasound. Thus, surgical intervention may be delayed which can lead to worsening necrosis and result in the need for resection of the affected tube. Methods. We reviewed two cases of fallopian tube torsion associated with hydatids of Morgagni in adolescent females. Results. The patients were premenarchal in both cases, aged 10 and 13 years. Both presented with acute clinical signs of ovarian torsion but ultrasound showed the ovary itself to be normal with an adjacent cystic structure. In both cases, the fallopian tube was detorsioned laparoscopically and preserved. The associated cyst was excised in one case and marsupialized in the other. Conclusions. We propose that prompt recognition and operative management of this relatively uncommon source of pelvic pain may prevent unnecessary tubal resection and improve long-term fertility in this population.
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Ormasa MCO, Hamouda ESM, Jung J. Isolated Fallopian Tube Torsion With Fimbrial Cyst In A 10 Year-old Girl Diagnosed By Ultrasound: A Case Report. J Radiol Case Rep 2016; 9:29-36. [PMID: 27200174 DOI: 10.3941/jrcr.v9i12.2565] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Torsion of the fallopian tube without the involvement of the ipsilateral ovary is a rare but important cause of acute abdominal pain in women as it is a surgical emergency. Although uncommon, it should be considered as one of the differential diagnosis in female children presenting with acute lower abdominal or pelvic pain. The diagnosis of isolated fallopian tube torsion is difficult pre-operatively and is often made during laparoscopic or surgical exploration because diagnostic features are usually non-specific. In this report, we present a case of isolated fallopian tube torsion with fimbrial cyst in a young female patient diagnosed pre-operatively by ultrasound.
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Affiliation(s)
| | | | - Jacqueline Jung
- Department of Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore
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Suggested spontaneous resolution of possible paediatric hydrosalpinx: a case report with discussion. GYNECOLOGICAL SURGERY 2016; 13:43-48. [PMID: 26918003 PMCID: PMC4753245 DOI: 10.1007/s10397-015-0925-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 11/17/2015] [Indexed: 10/25/2022]
Abstract
Hydrosalpinx is a rare cause of abdominal pain in paediatric patients, though cases are documented in the literature. Its aetiology differs considerably from traditional hydrosalpinx due to ascending sexually transmitted infection. Hydrosalpinx can resent mimicking an acute abdomen or can be asymptomatic. Management of paediatric hydrosalpinx varies but often involves surgical removal of the affected tube. A 12-year-old girl presented with left-sided acute abdominal pain setting within 24 h. Initial ultrasound scan suggested presence of hydrosalpinx. Post-discharge follow-up appointment with a consultant paediatric gynaecologist demonstrated no symptomology, but repeated scan by another sonographer showed continued presence of possible hydrosalpinx, which had since grown. Later, MRI was performed to confirm site of the lesion. However, MRI revealed no tubal masses, suggesting spontaneously resolved hydrosalpinx. Consultant-administered ultrasound scan confirm no tubal abnormalities. Our case suggests spontaneous resolution in possible paediatric hydrosalpinx. Our recommendation is for conservative management of asymptomatic paediatric and adolescent hydrosalpinges, with emergency surgery offered if symptoms indicative of tubal or adnexal torsion.
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Cabral MDI, Siqueira LM. Hydrosalpinx in Postmenarchal Nonsexually Active Girls: A Review of 6 Cases in a Children's Hospital. J Pediatr Adolesc Gynecol 2015; 28:e203-7. [PMID: 26117410 DOI: 10.1016/j.jpag.2015.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 06/15/2015] [Accepted: 06/17/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The objective of the study was to identify the presence of hydrosalpinx in postmenarchal nonsexually active girls in a children's hospital and to review the available literature on hydrosalpinx in this population. CASES In a tertiary care children's hospital, we performed a retrospective review of charts from January 1, 2000 to December 31, 2014 and identified six cases of hydrosalpinx in postmenarchal nonsexually active female adolescents ranging in age from 12 to 19 years old. The diagnosis of hydrosalpinx was made using imaging studies. Four of six patients were symptomatic at presentation, and two patients were diagnosed when seen for unrelated reasons. Five of these six girls had previous abdominopelvic surgery. Four girls were given empiric antibiotic treatment for presumed pelvic inflammatory disease related to hydrosalpinx. Two patients required surgical intervention that resulted in complete resolution of the hydrosalpinx. The oldest patient in the series underwent ultrasound-guided drainage of the pyo- and/or hydrosalpinx with subsequent recurrence with tubal ovarian abscess five months later. SUMMARY AND CONCLUSIONS The presence of hydrosalpinx might be discovered in the workup of pelvic pain in nonsexually active adolescents or on routine follow-up in patients with previous abdominal surgery, some of whom are asymptomatic. The underlying pathophysiology for hydrosalpinx in this population remains unclear. Among our cases, postsurgical adhesions appeared to be the most likely predisposing factor for tubular obstruction. Early detection and prompt diagnosis will allow for appropriate conservative or definitive treatment.
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Affiliation(s)
- Maria Demma I Cabral
- Division of Adolescent Medicine, Department of Pediatric Medicine, Nicklaus Children's Hospital, Miami Children's Health System, Miami, Florida.
| | - Lorena M Siqueira
- Division of Adolescent Medicine, Department of Pediatric Medicine, Nicklaus Children's Hospital, Miami Children's Health System, Miami, Florida
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Toyoshima M, Mori H, Kudo K, Yodogawa Y, Sato K, Kudo T, Igeta S, Makino H, Shima T, Matsuura R, Ishigaki N, Akagi K, Takeyama Y, Iwahashi H, Yoshinaga K. Isolated torsion of the fallopian tube in a menopausal woman and a pre-pubertal girl: two case reports. J Med Case Rep 2015; 9:258. [PMID: 26572791 PMCID: PMC4647800 DOI: 10.1186/s13256-015-0745-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 10/23/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Isolated torsion of the fallopian tube without an ovarian abnormality is an uncommon event, with an incidence of approximately 1 in 1,500,000 females. Isolated torsion of the fallopian tube occurs mostly in reproductive-aged women, and is thus extremely rare in menopausal women and pre-pubertal girls. CASE PRESENTATIONS In case 1, 63-year-old Japanese woman presented with a 2-day history of acute lower abdominal pain. Menopause occurred at 53 years of age. Pelvic ultrasonography showed an enlarged mass (73 × 47 mm) on the right side of her uterus. An urgent laparoscopy was performed based on a presumptive diagnosis of right ovarian tumor torsion. During the laparoscopy, we noted a black, necrotic, solid tumor arising from the distal end of her right fimbria. Her right fallopian tube was twisted with the tumor, but her right ovary was normal and not involved. A laparoscopic tumorectomy with a right salpingectomy was performed. Her post-operative course was uneventful. In case 2, a 10-year-old Japanese girl presented with a 1-day history of lower abdominal pain associated with nausea and vomiting. Menarche had occurred 2 months earlier. A computed tomography and magnetic resonance imaging examination demonstrated a dilated tubal cystic mass with a normal uterus and bilateral ovaries. An urgent laparoscopy was performed based on a presumptive diagnosis of right fallopian tube torsion. During laparoscopy, her right fallopian tube was noted to be dark red, dilated, and twisted several times. Her right fimbria was necrotic-appearing and could not be preserved. Therefore, a laparoscopic right salpingectomy was performed. A histologic examination revealed ischemic changes with congestion of her right fallopian tube, which was consistent with tubal torsion. She had an uncomplicated post-operative course. CONCLUSION We have presented two very rare cases of isolated fallopian tubal torsion. Radiologic interventions, such as computed tomography and magnetic resonance imaging, in addition to ultrasonography, are helpful diagnostic tools. Isolated torsion of the fallopian tube should be considered in the differential diagnosis of lower abdominal pain with a cystic mass and a normal ipsilateral ovary in all female patients, regardless of age.
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Affiliation(s)
- Masafumi Toyoshima
- Department of Obstetrics and Gynecology, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan. .,Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan.
| | - Hikaru Mori
- Department of Obstetrics and Gynecology, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan.
| | - Kei Kudo
- Department of Obstetrics and Gynecology, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan.
| | - Yuki Yodogawa
- Department of Obstetrics and Gynecology, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan.
| | - Kazuyo Sato
- Department of Obstetrics and Gynecology, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan.
| | - Takako Kudo
- Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan.
| | - Saori Igeta
- Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan.
| | - Hiromitsu Makino
- Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan.
| | - Takashi Shima
- Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan.
| | - Rui Matsuura
- Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan.
| | - Nobuko Ishigaki
- Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan.
| | - Kozo Akagi
- Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan.
| | - Yoichi Takeyama
- Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan.
| | - Hideki Iwahashi
- Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan. .,Department of Obstetrics and Gynecology, Self-Defense Force Sendai Hospital, Sendai, Japan.
| | - Kosuke Yoshinaga
- Department of Obstetrics and Gynecology, Sendai Medical Center, National Hospital Organization, 2-8-8, Miyagino, Miyagino-ku, Sendai, Miyagi, 983-8520, Japan.
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Abstract
Imaging is crucial in expediting the diagnosis and guiding definitive therapy in children with ovarian torsion. This article reviews the multimodality spectrum of imaging findings in pediatric ovarian torsion, focusing primarily on US appearances. We describe predisposing conditions that can lead to torsion, the pathological basis of the radiologic findings in ovarian torsion, and the common diagnostic pitfalls.
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Affiliation(s)
- Anh-Vu Ngo
- Department of Radiology, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way N.E., Seattle, WA, 98105, USA
| | - Jeffrey P Otjen
- Department of Radiology, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way N.E., Seattle, WA, 98105, USA
| | - Marguerite T Parisi
- Department of Radiology, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way N.E., Seattle, WA, 98105, USA
| | - Mark R Ferguson
- Department of Radiology, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way N.E., Seattle, WA, 98105, USA
| | - Randolph K Otto
- Department of Radiology, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way N.E., Seattle, WA, 98105, USA
| | - A Luana Stanescu
- Department of Radiology, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way N.E., Seattle, WA, 98105, USA.
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Kazmi Z, Gupta S. Best practice in management of paediatric and adolescent hydrosalpinges: a systematic review. Eur J Obstet Gynecol Reprod Biol 2015; 195:40-51. [PMID: 26476798 DOI: 10.1016/j.ejogrb.2015.09.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/17/2015] [Accepted: 09/25/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hydrosalpinx is a rare cause of abdominal pain in paediatric patients, though cases are documented in the literature. Its aetiology differs considerably from traditional hydrosalpinx due to ascending sexually transmitted infection. Hydrosalpinx can present mimicking an acute abdomen or can be asymptomatic. Management of paediatric hydrosalpinx varies, but often involves surgical removal of the affected tube. METHODS In June 2015, a literature search using relevant keywords was completed on MEDLINE and EMBASE databases to determine best management of paediatric hydrosalpinx. RESULTS We found 66 cases from 38 articles. Surgical intervention took place in 74% of cases (n=49). The most common surgical intervention was salpingectomy. In 3% of cases (n=2), nonsurgical medical management with hormonal therapy was utilized, with post-operative improvement in symptomology. In 23% of cases (n=15), conservative management was utilized: 2 of these cases torted, 4 cases persisted and 9 cases resolved. CONCLUSION Overall, the results of this review demonstrate that there are comparable outcomes between surgical, medical and conservative management. However, medical and conservative management was not often offered, and more research is needed on the subject.
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Affiliation(s)
- Zainab Kazmi
- University of Manchester School of Medicine, Stopford Building, Oxford Road, Manchester M13 9PT, United Kingdom.
| | - Sujata Gupta
- Women's Health Directorate, Royal Preston Hospital, Sharoe Green Lane North, Preston, Lancashire PR2 9HT, United Kingdom
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Romano M, Di Giuseppe J, Serri M, Noviello C, Martino A, Cobellis G, Ciavattini A. A possible association between sports and isolated fallopian tube torsion in children and adolescent females. Gynecol Endocrinol 2015; 31:688-92. [PMID: 26291807 DOI: 10.3109/09513590.2015.1056144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Isolated fallopian tube torsion (IFTT) is a rare occurrence characterized by the rotation of the fallopian tube on its own axis, without twisting the ipsilateral ovary. Pre-operative diagnosis is difficult due to the lack of specific clinical symptoms and radiological signs. The etiology is to date unknown and only some pre-disposing factors have been reported. The history, clinical presentation, laboratory findings and surgical treatment of five patients aged 12-16 with IFTT were evaluated. All patients came to be examined for worsening abdominal pain, nausea or vomiting. 75% of them practiced sports involving sudden changes in body position. They all underwent blood tests, ultrasound and Magnetic Resonance and then laparoscopy for the persistence of acute symptoms. Laparoscopic salpingectomy was performed in three patients. Another two needed a conversion to open salpingectomy due to the presence of pelvic adhesions. During the follow-up period, every girl was fine. The cause of IFTT is undetermined. In this series, a close association between IFTT and sports causing rapid body movements was found. The possibility of IFTT should be considered in the differential diagnosis of acute abdominal pain in children or adolescent females, especially if they practice sports.
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Affiliation(s)
- Mercedes Romano
- a S.O.D. di Chirurgia Pediatrica e delle Specialità Chirurgiche and
| | - Jacopo Di Giuseppe
- b Clinica Ostetrica e Ginecologica, Presidio Ospedaliero di Alta Specializzazione "G. Salesi" - Az. Ospedaliero - Universitaria Ospedali Riuniti di Ancona - Università Politecnica delle Marche , Ancona , Italy
| | - Matteo Serri
- b Clinica Ostetrica e Ginecologica, Presidio Ospedaliero di Alta Specializzazione "G. Salesi" - Az. Ospedaliero - Universitaria Ospedali Riuniti di Ancona - Università Politecnica delle Marche , Ancona , Italy
| | - Carmine Noviello
- a S.O.D. di Chirurgia Pediatrica e delle Specialità Chirurgiche and
| | - Ascanio Martino
- a S.O.D. di Chirurgia Pediatrica e delle Specialità Chirurgiche and
| | | | - Andrea Ciavattini
- b Clinica Ostetrica e Ginecologica, Presidio Ospedaliero di Alta Specializzazione "G. Salesi" - Az. Ospedaliero - Universitaria Ospedali Riuniti di Ancona - Università Politecnica delle Marche , Ancona , Italy
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Nair S, Joy S, Nayar J. Five year retrospective case series of adnexal torsion. J Clin Diagn Res 2014; 8:OC09-13. [PMID: 25653994 DOI: 10.7860/jcdr/2014/9464.5251] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 10/30/2014] [Indexed: 11/24/2022]
Abstract
AIMS AND OBJECTIVES Adnexal torsion is a rare gynaecological emergency that requires an early surgical intervention to save the adnexa from irreversible damage .Our study is about clinical presentation and management approach of adnexal torsion in a tertiary care centre. STUDY DESIGN Retrospective study. MATERIALS AND METHODS Review of case records during the five years of 2008 November -2013 November in Amrita Institute of Medical Sciences, Kochi, India. RESULTS Adnexal torsion was found mainly in the reproductive age. Ultrasound was the most commonly used imaging modality. Benign tumours predispose to torsion. Torsion occurred during postovulatory period in many cases. Polycystic ovaries were a risk factor for unexplained torsion in younger age groups. Diagnosis of adnexal torsion was mostly intra operative by direct visualisation of the rotated adnexa. Laparoscopy was the preferred method of surgical intervention. Ovarian conservation was tried in majority of the child bearing age groups. CONCLUSION Adnexal torsion is a rare emergency which requires a high index of clinical suspicion for diagnosis as the symptoms are non specific. Imaging helps in diagnosis but most of them are diagnosed intra operatively. Laparoscopic conservative surgery is the preferred surgical approach especially in younger age groups. An early surgical intervention helps in salvaging the adnexa and prevents further complications.
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Affiliation(s)
- Sobha Nair
- Assistant Professor, Department of Obstetrics and Gynaecology, Amrita Institute of Medical Sciences , Kochi, Kerala, India
| | - Smitha Joy
- Assistant Professor, Department of Obstetrics and Gynaecology, Amrita Institute of Medical Sciences , Kochi, Kerala, India
| | - Jayashree Nayar
- Professor, Department of Obstetrics and Gynaecology, Amrita Institute of Medical Sciences , Kochi, Kerala, India
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Narayanan S, Bandarkar A, Bulas DI. Fallopian tube torsion in the pediatric age group: radiologic evaluation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1697-1704. [PMID: 25154955 DOI: 10.7863/ultra.33.9.1697] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Fallopian tube torsion is a rare but important cause of acute pelvic pain in young adolescent girls. It is a surgical emergency treated with either detorsion or salpingectomy. The imaging findings can be nonspecific and challenging. However, an accurate early diagnosis is essential for prompt surgical treatment. Our objective was to review whether imaging findings can be specific enough to suggest the diagnosis of tubal torsion prospectively in the appropriate clinical setting. An Institutional Review Board-approved retrospective review of our imaging database from 2005 to 2012 revealed 10 surgically proven cases of fallopian tube torsion. All cases had sonography performed; 5 cases had additional multidetector computed tomography. All 10 patients (9-17 years) presented with acute pelvic pain. Sonographic findings included dilated tubular structures in 6 of 10 cases: adjacent to a normal ipsilateral ovary in 5 of 6 and adjacent to a benign ovarian teratoma in 1. In 4 cases, no dilated tube was identified; 3 of 4 had a cystic mass separate from the ovaries, and 1 had the imaging appearance of a multicystic ovary. Computed tomographic findings in the 5 cases that underwent multidetector computed tomography included a dilated tubular structure in 3 of 5; 2 of 5 had a cystic adnexal mass identified. Although rare, tubal torsion should be considered in female adolescents with acute pelvic pain. Sonography should be the first imaging choice. When a tubular structure or a midline cystic mass associated with a normal ipsilateral ovary is noted, tubal torsion should be considered in the differential diagnosis.
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Affiliation(s)
- Srikala Narayanan
- Division of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC USA
| | - Anjum Bandarkar
- Division of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC USA
| | - Dorothy I Bulas
- Division of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC USA.
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Višnjić S, Kralj R, Zupančić B. Isolated fallopian tube torsion with partial hydrosalpinx in a premenarcheal girl: a case report. J Med Case Rep 2014; 8:197. [PMID: 24939319 PMCID: PMC4088928 DOI: 10.1186/1752-1947-8-197] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 04/07/2014] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Isolated fallopian tube torsion as a complication of a preexisting hydrosalpinx is a rare finding in pediatric patients. The obvious rarity of this condition, its subtle diagnostic features and dissonant previous reporting about the appropriate therapeutic approach according to age, future conception capacity and potential complications of possible pregnancies make the decision about which surgical approach to use very difficult. In this report, we describe the case of a patient with such a presentation and review the literature. Very few similar reports of neosalpingostomy in pediatric patients have been published to date. CASE PRESENTATION In our present report, we describe the case of an 11-year-old Caucasian prepubertal girl who presented to our hospital with complaints of abdominal pain in the right lower quadrant, nausea and vomiting. The diagnostic workup led us to conclude that she had a torsion of the right ovary, which was cystically altered. Exploratory surgery revealed a partial hydrosalpinx and consecutive isolated torsion of the fimbrial part. The proximal isthmic part of the fallopian tube was intact and vital. Restorative surgery was performed to create a neosalpingostomy on the viable isthmic part of the tube and remove the cystic and twisted fimbrial and infundibular parts. CONCLUSION The surgical procedure described in this report is technically simple and feasible, but leaves doubts about the final outcome.
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Affiliation(s)
| | - Rok Kralj
- Pediatric Surgery Department, Children's Hospital Zagreb, Klaićeva 16, Zagreb, Croatia.
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Isolated fallopian tube torsion in adolescents. Case Rep Obstet Gynecol 2013; 2013:341507. [PMID: 24251052 PMCID: PMC3819798 DOI: 10.1155/2013/341507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 09/06/2013] [Indexed: 12/04/2022] Open
Abstract
Background. Fallopian tube torsion is a rare cause of acute abdomen, occurring commonly in females of reproductive age. It lacks pathognomonic symptoms, signs, or imaging features, thus causing delay in surgical intervention. Case. We report two cases of isolated fallopian tube torsion in adolescent girls. In the first case a 19-year-old patient presented with acute pain in the left iliac region associated with episodes of vomiting for one day and mild tenderness on examination. Laparoscopy revealed left sided twisted fallopian tube associated with hemorrhagic cyst of ovary. The tube was untwisted and salvaged. In another case an 18-year-old virgin girl presented with similar complaints since one week, associated with mild tenderness in the lower abdomen and tender cystic mass on per rectal examination. On laparoscopy right twisted fallopian tube associated with a paratubal cyst was found. Salpingectomy was done as the tube was gangrenous. Conclusion. Fallopian tube torsion, though rare, should be considered in women of reproductive age with unilateral pelvic pain. Early diagnostic laparoscopy is important for an accurate diagnosis and could salvage the tube.
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An uncommon twist: isolated fallopian tube torsion in an adolescent. Case Rep Surg 2013; 2013:509424. [PMID: 24024061 PMCID: PMC3760127 DOI: 10.1155/2013/509424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 07/22/2013] [Indexed: 11/25/2022] Open
Abstract
We report a 13-year-old girl with bilateral paratubal cysts and left isolated fallopian tube torsion (IFTT). Paratubal cysts are uncommon in children, and IFTT is a rare complication. Awareness of this entity and prompt surgical intervention could potentially salvage the fallopian tube preserving fertility.
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Casey RK, Damle LF, Gomez-Lobo V. Isolated fallopian tube torsion in pediatric and adolescent females: a retrospective review of 15 cases at a single institution. J Pediatr Adolesc Gynecol 2013; 26:189-92. [PMID: 23642839 DOI: 10.1016/j.jpag.2013.02.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 02/13/2013] [Accepted: 02/19/2013] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE To identify and review cases of isolated fallopian tube torsion (FTT) at our institution to further characterize diagnosis and management. DESIGN Retrospective review. SETTING Tertiary care medical center. PARTICIPANTS Case series of pediatric and adolescent females, <21 years old, with operatively diagnosed isolated fallopian tube torsion from our institution. INTERVENTION None. MAIN OUTCOME MEASURE Isolated fallopian tube torsion. RESULTS Fifteen cases of isolated fallopian tube torsion were identified based on intraoperative diagnosis. Patient ages ranged from 8-15 years old, mean age of 12. Fourteen patients (93%) presented with abdominal pain, 8 (53%) localized to the side of associated torsion. Ultrasonography reports described a tubular structure in 4 patients and an associated ovarian or paraovarian cyst in eleven patients. Suspicion of fallopian tube torsion was only described for those patients with a tubular structure described on ultrasonography report. Intraoperatively, 7 patients (47%) were found to have no associated pathology and 8 (53%) were found to have associated cyst or hydrosalpinx. Eight (53%) patients underwent salipingectomy and 7 (47%) underwent reversal of torsion with drainage of associated cyst or cystectomy. CONCLUSIONS Isolated fallopian tube torsion is a rare condition that seems to occur in younger adolescents. Vague clinical presentation contributes to low preoperative suspicion. Preoperative suspicion may be increased based on radiographic findings of an enlarged tubular structure or an adjacent normal ovary. Management may be considered nonemergent and salpingectomy is controversial. Long-term fertility outcomes must be further assessed for more definitive decisions regarding surgical management.
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Affiliation(s)
- Rachel K Casey
- Department of Obstetrics and Gynecology, The George Washington University Medical Center, Children's National Medical Center, Washington, DC 20037, USA.
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Pampal A, Atac GK, Nazli ZS, Ozen IO, Sipahi T. A rare cause of acute abdominal pain in adolescence: hydrosalpinx leading to isolated torsion of fallopian tube. J Pediatr Surg 2012; 47:e31-4. [PMID: 23217913 DOI: 10.1016/j.jpedsurg.2012.08.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 07/04/2012] [Accepted: 08/23/2012] [Indexed: 10/27/2022]
Abstract
Torsion of the fallopian tube accompanying hydrosalpinx is a rare occurrence in the pediatric population. This report describes a 13 year old sexually inactive girl with isolated tubal torsion due to hydrosalpinx. The girl had lower left abdominal pain for two days. The physical examination revealed left lower quadrant tenderness with a firm round anterior mass on rectal examination. Abdominal ultrasound showed left tubal enlargement with free pelvic peritoneal fluid. Magnetic Resonance Imaging (MRI) showed engorgement and dilatation of the left fallopian tube without contrast enhancement suspicious of tubal torsion. At operation, torsion of the left tube on its longitudinal axis was observed, and a salpingectomy was performed. Although rare, the diagnosis of torsion of the fallopian tube should be considered when evaluating acute abdominal pain. The earlier tubal torsion is diagnosed, the greater the likelihood of salvaging the fallopian tube.
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Affiliation(s)
- Arzu Pampal
- Department of Pediatric Surgery, Ufuk University, Faculty of Medicine, Ankara, Turkey.
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Abstract
PURPOSE OF REVIEW Evaluation of the child with acute abdominal pain is challenging because of the wide range of potential diagnoses. Presenting symptoms, clinical examination, and laboratory findings can guide selection of diagnostic imaging. RECENT FINDINGS Intussusception and intestinal malrotation are potentially serious causes of intestinal obstruction, which are best evaluated by ultrasound and upper gastrointestinal series, respectively. Ultrasound has diagnostic importance in the evaluation of multiple diseases, including appendicitis, by potentially decreasing the need for inpatient observation, cholecystitis and complications of gall stones such as pancreatitis, and ovarian diseases. Pelvic inflammatory disease should be considered in evaluation of a teenage girl with lower abdominal pain. Less common causes of acute abdominal pain include ingested foreign bodies, infected congenital anomalies, and perforated peptic ulcer disease. SUMMARY Presenting symptoms and physical examination findings can narrow the number of potential diagnoses in pediatric acute abdominal pain and thereby guide diagnostic imaging selection. Abdominal/pelvic ultrasound, rather than computed tomography scan, is the preferred modality for initial evaluation of many potential causes of pediatric abdominal pain.
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